| NPI | 1922375260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0442045) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A123080) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: MO 2022038723) | |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2022-11-03 |