| NPI | 1730618430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0090727) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-09191) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2021-04-27 |