| NPI | 1932190683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16417) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 0530324) |
| 207P00000X Emergency Medicine (Licence: NV CL0025) | |
| 207P00000X Emergency Medicine (Licence: FL OS16417) | |
| 207Q00000X Family Medicine (Licence: KS 0530324) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2020-01-24 |