| NPI | 1689016412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-37537) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9408267) |
| 208000000X Pediatrics (Licence: ID M-14360) | |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2021-02-12 |