| NPI | 1659361632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-32339) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 35220) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2014-05-19 |