| NPI | 1174781975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-33279) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2008020594) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2021-01-14 |