| NPI | 1871588954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO MD R4490) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-15449) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2009-03-20 |