| NPI | 1750499984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-30887) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 2158) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2022-08-05 |