| NPI | 1962628529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 6540) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 242380) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2019-01-29 |