| NPI | 1497749295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2024000134) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0527608) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2025-03-21 |