| NPI | 1063824068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0439647) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN20246) |
| Enumeration Date | 2014-05-24 |
| Last Update Date | 2018-04-24 |