| NPI | 1558725218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 64088) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 27786) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2018-07-19 |