| NPI | 1386955334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2016028966) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0536409) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2018-01-29 |