| NPI | 1144894734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0449543) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-10492) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2024-08-15 |