| NPI | 1609853787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MN 28497) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 28497) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2008-04-07 |