| NPI | 1235241779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-21464) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: KS 04-21464) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-06-09 |