| NPI | 1891083382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2021011439) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-40829) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2022-02-24 |