| NPI | 1407944887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-22544) |
| Additional Taxonomies | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: KS 04-22544) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2011-02-28 |