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 |