| NPI | 1063477966 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0425038) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: KS 0425038) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2017-10-03 |