| NPI | 1083875215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 26791) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 51861) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2017-02-17 |