NPI | 1962402537 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-19457) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 2082) |
Enumeration Date | 2005-07-26 |
Last Update Date | 2018-02-08 |