| NPI | 1255416558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-32164) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125055317) |
| 207Q00000X Family Medicine (Licence: OK 35959) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: KS 04-32164) | |
| 208D00000X General Practice (Licence: KS 04-32164) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2020-08-20 |