| NPI | 1508875352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-23075) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME127578) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2024-02-01 |