| NPI | 1033297122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0437701) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 30976) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2015-01-14 |