| NPI | 1043241201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 28471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G30137) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2007-07-08 |