| NPI | 1821407644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81522-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 5862) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2024-08-21 |