| NPI | 1811967391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 15613) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 39122) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2022-11-01 |