| NPI | 1902244965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-39016) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 9408190) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2016-07-21 |