| NPI | 1215929229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0433006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO MD118620) |
| 208000000X Pediatrics (Licence: MO MD118620) | |
| 208000000X Pediatrics (Licence: KS 0433006) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2019-09-20 |