| NPI | 1982789384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2000160557) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 04-31361) |
| 207Q00000X Family Medicine (Licence: KS 04-31361) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-03-27 |