| NPI | 1609095173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9701440) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0431536) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2025-03-21 |