| NPI | 1114944071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 39062) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 9494) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2018-12-14 |