| NPI | 1447664396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: KS 0540072) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2014019003) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2023-12-06 |