| NPI | 1811953235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-21495) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R9F66) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2019-05-14 |