| NPI | 1942659941 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-41407) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-08973) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2022-11-07 |