| NPI | 1467680900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022014480) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-35558) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2024-07-11 |