| NPI | 1508838772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2017-01841) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-19701) |
| 207Q00000X Family Medicine (Licence: MO 2017022370) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2022-10-24 |