| NPI | 1639457419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 69242) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 62300-20) |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2024-01-16 |