| NPI | 1609813674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 802) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0516910) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2011-07-22 |