| NPI | 1396719035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 0530786) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2005018834) |
| 207Q00000X Family Medicine (Licence: KS 0530786) | |
| 207Q00000X Family Medicine (Licence: KS 05-30786) | |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2021-01-11 |