| NPI | 1184061608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-37590) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9408164) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2018-01-05 |