| NPI | 1114205077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 05-37288) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5315051258) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2022-07-21 |