| NPI | 1154357929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-34692) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2010009597) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2020-03-18 |