| NPI | 1639369960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2010026627) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-44015) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2025-07-22 |