| NPI | 1275750051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0432333) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 6346) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2019-10-16 |