| NPI | 1871756882 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 05-35162) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2008016714) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2020-12-09 |