| NPI | 1891801692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0422070) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R3H04) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2022-10-11 |