| NPI | 1336325646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0536209) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 568) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2014-07-21 |