| NPI | 1740774447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-44339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2018020668) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2021-09-30 |