| NPI | 1164632717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME119208) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L2694) |
| 207Q00000X Family Medicine (Licence: KS 04-33895) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2024-08-01 |