| NPI | 1386740843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 57061) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 43835) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2019-11-25 |