| NPI | 1073537742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-23329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R4C99) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2018-01-31 |