| NPI | 1164417515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 3185) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: KS 27912) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2014-01-15 |