| NPI | 1154635639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-36337) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP01959) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2018-09-04 |