| NPI | 1255396115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 49905) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-120148) |
| 207R00000X Internal Medicine (Licence: WI 46423) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2023-01-12 |