| NPI | 1144754953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0446237) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 04-46237) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2024-11-13 |