| NPI | 1114908779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 0055180) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0430861) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2021-04-22 |