| NPI | 1467452904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-25637) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-25637) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2009-12-17 |