| NPI | 1427552421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 9412201) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A165473) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2025-06-24 |