| NPI | 1376523563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-14838) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R3509) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2011-09-16 |