| NPI | 1275054397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-43709) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2017022151) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2020-08-26 |