| NPI | 1801163639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM A175513) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101018737) |
| 207Q00000X Family Medicine (Licence: KS 05-38958) | |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2023-01-18 |