| NPI | 1255311866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 22578) |
| Additional Taxonomies | 174400000X Specialist (Licence: MN 022578) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2014-07-29 |