| NPI | 1568667798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-33281) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 046801) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2012-06-04 |