| NPI | 1275502882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-22558) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KS 05-22558) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2007-07-08 |