| NPI | 1740381052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 32351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2007001370) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2012-05-31 |