| NPI | 1467414854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-15928) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 34964) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2008-12-12 |