| NPI | 1396793741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-13524) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 21750) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2020-09-28 |