| NPI | 1679702724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MN 52385) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 104488) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207R00000X Internal Medicine (Licence: MN 52385) | |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2011-06-30 |