| NPI | 1114949179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0530413) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 3867) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2015-04-06 |