| NPI | 1003345471 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-43379) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-09265) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2021-01-21 |