| NPI | 1548721301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 94-10049) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-10049) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2023-06-23 |