| NPI | 1942391248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-25297) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 102060) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2017-05-25 |