| NPI | 1205814449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 26016) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-29587) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2019-09-25 |