| NPI | 1013995802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 60672) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 35727-020) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2016-10-06 |