| NPI | 1912110578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 26711) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301082389) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI 4301082389) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OK 26711) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: MI 4301082389) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: OK 26711) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2011-08-26 |