| NPI | 1912946377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 42082) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0431195) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2023-02-20 |