| NPI | 1154761609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2021034754) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-42839) |
| 207Q00000X Family Medicine (Licence: KS 04-39379) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2021-11-15 |