| NPI | 1023350899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-37540) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 05-37540) |
| 207P00000X Emergency Medicine (Licence: MI 5101022930) | |
| 207Q00000X Family Medicine (Licence: MI 5101022930) | |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2024-11-01 |