| NPI | 1619469145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2021007722) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-09504) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2021-11-28 |