| NPI | 1003800459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-27401) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 113668) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2019-11-11 |