| NPI | 1376701144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-33980) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 6964) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2021-10-27 |