| NPI | 1285633651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-23848) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 523848) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2024-02-05 |