| NPI | 1588634224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 31267) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2004012747) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2009-11-16 |