| NPI | 1124245915 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0433709) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 0433709) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2023-06-12 |