| NPI | 1821064114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-21220) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0055619) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2017-09-26 |