| NPI | 1801854294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO R3D59) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0419017) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2021-11-01 |