| NPI | 1366593915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-34857) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 94-06448) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-02-04 |