| NPI | 1790165728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 94-08612) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-08612) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2021-04-01 |