| NPI | 1689614752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0416306) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R7110) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2011-05-26 |