| NPI | 1194085449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 59863) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR LL158695) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2016-03-09 |