| NPI | 1053428508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 16719) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 19264-20) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2015-12-29 |