| NPI | 1962505081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO R6B11) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0420798) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2011-12-02 |