| NPI | 1902895477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0009256) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 31049) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2010-03-19 |