| NPI | 1578549002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 430979) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 20250) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2007-07-08 |