| NPI | 1679595144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 26021) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0417821) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2014-04-29 |