| NPI | 1861485187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT 4511) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AK AA2921) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2022-07-21 |