| NPI | 1124432992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 10138818-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9408360) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2023-11-27 |