| NPI | 1063618544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-33447) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 046825) |
| 208000000X Pediatrics (Licence: KS 04-33447) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2016-12-13 |