| NPI | 1780612861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0526616) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 103308) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2018-02-23 |