| NPI | 1184719627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-44183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2006014607) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-11-06 |