| NPI | 1396242731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-45085) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 010719) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2023-11-27 |