| NPI | 1417054362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: KS 04-28352) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0428352) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-06-05 |