| NPI | 1861426769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 08-00265) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0800265) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2009-02-10 |