| NPI | 1639160633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-21443) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R8H49) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2021-09-17 |