| NPI | 1114996907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2019001303) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 24750) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2019-02-12 |