| NPI | 1548619968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022018035) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-41354) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2024-04-30 |