| NPI | 1174550313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2008021948) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-38315) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2024-01-12 |