| NPI | 1457429524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0424605) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 102648) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2023-01-20 |