| NPI | 1518307602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-39209) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 9408130) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2020-02-12 |