| NPI | 1124067319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 57551) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 41212) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2020-11-10 |