| NPI | 1568651305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 55159) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT187849) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2015-07-06 |