| NPI | 1114379534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-41883) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301109524) |
| Enumeration Date | 2016-07-09 |
| Last Update Date | 2022-08-25 |