| NPI | 1871581306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-31311) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-11593) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: KS 31311) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2020-05-20 |