| NPI | 1497031967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2020032506) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0537168) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2021-11-01 |