| NPI | 1205823887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 100308) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-29021) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2008-01-29 |