| NPI | 1669498010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 431029) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 0431029) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2014-04-21 |