| 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 |