| NPI | 1619962099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-19699) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R7P64) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2022-02-03 |