| NPI | 1700269537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01087799A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-08699) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2022-07-26 |