| NPI | 1700014271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 7212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 5821) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2024-04-09 |