| NPI | 1386625192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 35204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 46206) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2020-12-04 |