| NPI | 1699349704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-49846) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-10808) |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2024-08-28 |