| NPI | 1386635027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04 28583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 55916) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2017-04-07 |