| NPI | 1932326071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2009032076) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 6623) |
| 207Q00000X Family Medicine (Licence: KS 04-32543) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2022-03-29 |