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 |