| NPI | 1689024382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-42282) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2018039700) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2023-10-23 |