| NPI | 1699791871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-25135) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R6H89) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2011-08-15 |