| NPI | 1194748392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0428676) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2002008177) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-08-30 |