| NPI | 1619315660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 60482) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 256436) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2020-10-08 |