| NPI | 1548799919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 89791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-09260) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2022-04-12 |