| NPI | 1164458907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0429916) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: KS 0429916) |
| 207R00000X Internal Medicine (Licence: MO 2002028986) | |
| 207R00000X Internal Medicine (Licence: KS 04-29916) | |
| 208000000X Pediatrics (Licence: MO 2002028986) | |
| 208000000X Pediatrics (Licence: KS 04-29916) | |
| 208M00000X Hospitalist (Licence: MO 2002028986) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2017-10-26 |