| NPI | 1114117934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 50961) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 43084) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2020-08-20 |