| NPI | 1679969307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 5693-851) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 66853-20) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2017-02-08 |