| NPI | 1285604256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 51616) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G54609) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2011-11-22 |