| NPI | 1780666818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO R8666) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-31571) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2022-01-26 |