| NPI | 1124400478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-48035) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2023032214) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2023-10-31 |