| NPI | 1891059333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD173328) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-08019) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2023-08-03 |