| NPI | 1528355062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 58156) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199047) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2020-11-10 |