| NPI | 1720067747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C10005349) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: FL C100005349) |
| 207QA0000X Family Medicine Adolescent Medicine (Licence: DE C100005349) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2011-06-16 |