| NPI | 1316023492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 44448) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 20592) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2015-12-20 |