| NPI | 1982964607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2015015365) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-38164) |
| 207R00000X Internal Medicine (Licence: OK 29180) | |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2020-10-27 |