| NPI | 1013980218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 41807) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 29485) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2020-08-12 |