| NPI | 1043352115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS KS0432470) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-32470) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2018-05-01 |