| NPI | 1356396394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 56842) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 30280) |
| 207R00000X Internal Medicine (Licence: MT 12045) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2014-05-12 |