| NPI | 1275793622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 53849) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 51459) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2020-11-10 |