| NPI | 1316179849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-35216) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 5980) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2014-06-24 |