| NPI | 1881689594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-32392) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO MD110096) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2014-06-09 |