| NPI | 1619027554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-29411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 31620) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2012-03-28 |