| NPI | 1922086693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023014079) |
| Additional Taxonomies | 202K00000X (Licence: KS 0519455) |
| 207Q00000X Family Medicine (Licence: KS 05-19455) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2023-06-13 |