| NPI | 1609857192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-20563) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: KS 04-20563) |
| 207P00000X Emergency Medicine (Licence: KS 20563) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: KS 04-20563) | |
| 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: KS 04-20563) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2021-09-17 |