| NPI | 1306296496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 26861) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-08880) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2019-08-15 |