| NPI | 1528684297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81457-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 81457-20) |
| 207Q00000X Family Medicine (Licence: KS 94-10395) | |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2023-08-08 |