| NPI | 1376705871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: KS 0440451) |
| Additional Taxonomies | 2085R0001X (Licence: AZ 47963) |
| 207R00000X Internal Medicine (Licence: IA R8479) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2025-12-16 |