| NPI | 1235469503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 28366) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN12648) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2011-06-03 |