| NPI | 1942269121 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-24755) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0424755) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2010-09-22 |