| NPI | 1386910107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 65511) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC DO034502) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2020-08-19 |