| NPI | 1366468696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS KS 04-32933) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 49207-020) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2011-10-18 |