| NPI | 1497017149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0438204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 9407909) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2015-07-20 |