| NPI | 1285014225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05162) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-08602) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2023-02-26 |