| NPI | 1679833800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 05-47099) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2015014048) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2023-04-04 |