| NPI | 1134860497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-51175) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2025010902) |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2025-07-10 |