| NPI | 1689667628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO R2D36) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-26894) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2020-11-25 |