| NPI | 1730234303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-32919) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2008008652) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2020-10-08 |