| NPI | 1285731752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081H0002X (Licence: KS 04-16260) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-16260) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2007-07-08 |