| NPI | 1841729217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-43043) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-09263) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2020-09-02 |