| NPI | 1215933122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 28256) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 63014) |
| 207R00000X Internal Medicine (Licence: IA 44672) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2017-11-06 |