| NPI | 1013941038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0426014) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0426014) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-07-08 |