| NPI | 1760410559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-29370) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0429370) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2017-12-29 |