| NPI | 1982864054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 21864) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-34798) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2013-11-25 |