| NPI | 1104806728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 021074) |
| Additional Taxonomies | 174400000X Specialist (Licence: MN 021074) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2022-03-25 |