| NPI | 1558503037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 58524) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 11759) |
| 207R00000X Internal Medicine (Licence: PA mt194378) | |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2021-03-23 |