| NPI | 1215978069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 51007) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 45478-020) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2020-11-10 |