| NPI | 1649265729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO MD R7498) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-26178) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2022-02-11 |