| NPI | 1205819745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: MN 35633) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 35633) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2018-02-12 |