| NPI | 1245205640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 24969) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME147874) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MN 24969) | |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2021-06-10 |