| NPI | 1639730120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO3570) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019022854) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2023-12-07 |