| NPI | 1841816840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-50962) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-50962) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2025-05-01 |