| NPI | 1902897903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO R9E32) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-25242) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2022-01-20 |