| NPI | 1174513659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 33750) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 41640) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2021-03-16 |