| NPI | 1164427860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-24798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 101923) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2025-11-03 |