| NPI | 1265408983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0431904) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 6104) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2021-03-23 |