| NPI | 1558341347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-33483) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R1A61) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2009-06-16 |