| NPI | 1376980458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-38090) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9408187) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2022-11-04 |