| NPI | 1639330822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 52490) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301100558) |
| 208600000X Surgery (Licence: MN 52490) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2022-02-17 |