| NPI | 1922032333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO198303) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0530778) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2020-11-02 |