| NPI | 1518540434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-49664) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 86131) |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2024-07-16 |