| NPI | 1427311091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101258768) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-07920) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2015-08-10 |