| NPI | 1487764957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 3769) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 05-31486) |
| 207Q00000X Family Medicine (Licence: KS 05-31486) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-08-10 |