| NPI | 1861593964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-24688) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R4P35) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2017-05-25 |