| NPI | 1598146409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 94-08570) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-39450) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2021-04-26 |