| NPI | 1063486801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-36926) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2014013905) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2016-06-13 |