| NPI | 1043705759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-46235) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 313577) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2022-07-20 |