| NPI | 1457544892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 275558) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 036-129268) |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2020-12-08 |