| NPI | 1104009505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 51992-020) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-118929) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2024-09-17 |