| NPI | 1629414412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101021067) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9408137) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2014-05-15 |