| NPI | 1982697967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-13726) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R6063) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2015-04-02 |