| NPI | 1164629218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0432319) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9406871) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2022-12-06 |