| NPI | 1609216514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 31541) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.142455) |
| 207R00000X Internal Medicine (Licence: IL 125.062531) | |
| 207R00000X Internal Medicine (Licence: MA 270233) | |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2022-09-28 |