| NPI | 1356309538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0429292) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 36586) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2007-11-12 |