| NPI | 1821080094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-35241) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012031797) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2026-01-12 |