| NPI | 1952330565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 070906) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS AS7555797) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2022-01-10 |