| NPI | 1124347083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 7365) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 50563) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2015-06-03 |