| NPI | 1710925888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-20168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-20168) |
| 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: KS 04-20168) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2021-02-11 |