| NPI | 1467005108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 05-51732) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2022026886) |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2026-03-30 |