| NPI | 1992797815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 36356) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0429484) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2013-04-11 |