| NPI | 1710428933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-42966) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-09182) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2020-06-11 |