| NPI | 1831175918 |
|---|---|
| Other Name | KEN PARK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C51444) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA C51444) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2021-03-23 |