| NPI | 1538159421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2003019567) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-30659) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2012-11-07 |