| NPI | 1033299987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2017038663) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0528427) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2018-03-17 |