| NPI | 1386704039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 17141) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-30662) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2023-02-02 |