| NPI | 1184666323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: MN 48263) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 48263) |
| 202K00000X (Licence: CO 49096) | |
| 207R00000X Internal Medicine (Licence: CO 49096) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2021-07-16 |