| NPI | 1861712721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 27861) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 7396) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2023-01-25 |