| NPI | 1336150259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 36333) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 46560-20) |
| 207R00000X Internal Medicine (Licence: CO 27582) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2011-03-08 |