| NPI | 1912909052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-39409) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2005013269) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2023-10-18 |