| NPI | 1679002224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 05-42948) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-09310) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2023-07-17 |