| NPI | 1700851912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2013021745) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04 20555) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2022-11-08 |