| NPI | 1164538989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-22876) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R9H69) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2022-10-06 |