| NPI | 1619173143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M11763) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID M11763) |
| 207Q00000X Family Medicine (Licence: KS 046841) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2022-03-17 |