| NPI | 1952396905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO MD 111602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0422753) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2009-08-18 |