| NPI | 1801912605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-14418) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 109097) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2020-01-13 |