| NPI | 1124013297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2000156447) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-27650) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2022-01-28 |