| NPI | 1336103134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R7325) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-16907) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2018-11-06 |