| NPI | 1104939578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS009599L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C2-0005782) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2008-05-29 |