| NPI | 1861443749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0425965) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 0425965) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2011-09-29 |