| NPI | 1669586855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 0429100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301059161) |
| 207R00000X Internal Medicine (Licence: OH 35078755) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2007-07-08 |