| NPI | 1669095840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: NC 2025-02186) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-10252) |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2026-01-08 |