| NPI | 1093823353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 46599) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 63688) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2021-03-11 |