| NPI | 1710939996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 48782) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 10528) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2013-12-13 |