| NPI | 1780637868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0520840) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R4C55) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2013-09-24 |