| NPI | 1083618839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 18555) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 0418555) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2011-05-16 |