| NPI | 1639518525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-39243) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2013020329) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2020-08-10 |