| NPI | 1588190276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0443442) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0006523) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2020-08-26 |