| NPI | 1194784629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 50200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 45886) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2012-06-11 |