| NPI | 1922094655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 3559) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 36-103958) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2024-02-01 |