| NPI | 1780945295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2015030395) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-38098) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2022-11-22 |