| NPI | 1902219835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04962) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-08328) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2020-07-08 |