| NPI | 1396921342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 69888) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.120901) |
| 207R00000X Internal Medicine (Licence: WA MD60238852) | |
| Enumeration Date | 2008-01-20 |
| Last Update Date | 2023-08-14 |