| NPI | 1811334550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-39959) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2016027615) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2018-02-27 |