| NPI | 1154411874 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-26383) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 10507) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2011-05-20 |