| NPI | 1366606923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2017016279) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-34960) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2022-04-12 |