| NPI | 1396763066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 51470) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 24195) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2012-09-26 |