| NPI | 1336192442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-39657) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2025015861) |
| 207Q00000X Family Medicine (Licence: SC 24070) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2026-01-26 |