| NPI | 1336571900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2016008771) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-25402) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2023-11-20 |