| NPI | 1720425242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 9408101) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-43099) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2016-07-25 |