| NPI | 1154343705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 32265) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 6941) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2019-12-03 |