| NPI | 1467745927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 59408) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R2758) |
| 208000000X Pediatrics (Licence: MN 59408) | |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2024-04-23 |