| NPI | 1184690695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: KS 0421046) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0421046) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: KS 0421046) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: KS 0421046) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2025-09-11 |