| NPI | 1770218034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 9412) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 05-51606) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2025-08-26 |