| NPI | 1609863000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-30794) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 0430794) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2009-10-21 |