| NPI | 1710944764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO R6157) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0414225) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2012-07-25 |