| NPI | 1740509819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-35337) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 7376) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2018-01-04 |