| NPI | 1437565272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-39002) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-08514) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2018-08-03 |