| NPI | 1912530890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 53-79338-122) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MO 2020005634) |
| 207Q00000X Family Medicine (Licence: MO 2020005634) | |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2021-12-17 |