| NPI | 1245452705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2021043408) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-34548) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2026-01-08 |