| NPI | 1487799110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 65750) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AK 3297) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2022-02-16 |