| NPI | 1639164221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO MD R9F30) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 05-21341) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2022-02-10 |