| NPI | 1790756856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-43901) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 3753) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2020-11-12 |