| NPI | 1225295223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020032446) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-33834) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2023-01-12 |