| NPI | 1699208447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 0443239) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2020008152) |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2025-07-21 |