| NPI | 1255695482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-38961) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 9407949) |
| 207P00000X Emergency Medicine (Licence: MO 2020010409) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2021-01-12 |