| NPI | 1598914194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101018019) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-24102) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2016-03-18 |