| NPI | 1174633085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-1071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 2688) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-13 |