| NPI | 1942263215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS KS0425521) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0425521) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2023-12-22 |