| NPI | 1336700830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-06358) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-10060) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2023-12-29 |