| NPI | 1891826269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-45220) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0061567) |
| 207Q00000X Family Medicine (Licence: MO 2005019384) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2024-03-07 |