| NPI | 1003840547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0531375) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2016016988) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2022-07-21 |