| NPI | 1265226732 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 9412170) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 9412170) |
| Enumeration Date | 2025-04-08 |
| Last Update Date | 2025-06-11 |