| NPI | 1134742869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 94-10257) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301518338) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2026-08-31 |