| NPI | 1124462932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 16628) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 29967) |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2016-10-20 |