| NPI | 1629093521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-35296) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD418492) |
| 207R00000X Internal Medicine (Licence: WA MD60092328) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2021-04-27 |