| NPI | 1568468726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2015000712) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2015000712) |
| 207Q00000X Family Medicine (Licence: KS 0420729) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2021-10-06 |