| NPI | 1104054667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-34590) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 7219) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2012-11-30 |