| NPI | 1386908341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A142654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 56683) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2022-03-08 |