| NPI | 1093703373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 18512) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R9433) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2012-04-30 |