| NPI | 1710942891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 33455) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2002012703) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2022-06-14 |