| NPI | 1497851133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 62689) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 31194) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2023-10-31 |