| NPI | 1255361796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 24977) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 13489) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2009-11-30 |