| NPI | 1255410635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 4-18220) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: KS 4-18220) |
| Enumeration Date | 2006-11-04 |
| Last Update Date | 2013-03-06 |