| NPI | 1316996994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-31637) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2006009459) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2022-10-06 |