| NPI | 1558867580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-45030) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2018023424) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2021-07-28 |