| NPI | 1437146214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0532425) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2004017424) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2022-02-09 |