| NPI | 1851357453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO MDR9576) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0420681) |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2007-07-08 |