| NPI | 1821400078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-38008) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-08342) |
| 207Q00000X Family Medicine (Licence: MO 2021030370) | |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2026-08-03 |