| NPI | 1942239355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS KS04-36762) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 25800) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2026-06-30 |