| NPI | 1518195213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-34709) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 7243) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2018-08-03 |