| NPI | 1316400443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0446526) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2022032984) |
| Enumeration Date | 2019-04-06 |
| Last Update Date | 2024-03-06 |