| NPI | 1578603163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 51495) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 41631) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-08-14 |