| NPI | 1366504128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 51162) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-4666) |
| 207R00000X Internal Medicine (Licence: MN 103700) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2012-12-05 |