| NPI | 1619314796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 52842) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9408168) |
| 207Q00000X Family Medicine (Licence: KS 04-38474) | |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2023-10-11 |