| NPI | 1861468696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0422190) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP928) |
| 207Q00000X Family Medicine (Licence: MO 2015036599) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2016-08-24 |