| NPI | 1730154543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-20450) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0420450) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2021-06-30 |