| NPI | 1376615690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 100852) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-28164) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2018-02-23 |