| NPI | 1699769844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0420182) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: KS 0420182) |
| 207P00000X Emergency Medicine (Licence: KS 0420182) | |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2011-09-08 |