| NPI | 1972723955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020008340) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-32789) |
| 207Q00000X Family Medicine (Licence: IA 04040) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2021-09-17 |