| NPI | 1639203276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0426398) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 0426398) |
| 207P00000X Emergency Medicine (Licence: IA 39462) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-06-24 |