| NPI | 1841412376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-32861) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 0532861) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2014-04-02 |