| NPI | 1669554176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0432505) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2002008186) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2025-09-10 |