| NPI | 1235132622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018036669) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-37036) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2021-05-12 |