| NPI | 1245724749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-46471) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN26934) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2022-08-01 |