| NPI | 1629075379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 28175) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-21407) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2014-10-20 |