| NPI | 1164486254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2005039937) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 05-32227) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2022-07-25 |