| NPI | 1225094790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 46791) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 55388-020) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2021-02-17 |