| NPI | 1255467841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 68479) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 45337) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2021-04-21 |