| NPI | 1366435455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 35435) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 114746) |
| 207R00000X Internal Medicine (Licence: KS 04-27448) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2021-01-27 |