| NPI | 1013470574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 390200000X) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 04-46631) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2024-01-29 |