| NPI | 1255393476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 34636) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME80859) |
| 207R00000X Internal Medicine (Licence: NV 12513) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2019-07-12 |