| NPI | 1710095039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 34730) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-38088) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2024-05-20 |