| NPI | 1851466171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 21486) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS B21486) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2022-02-11 |