| NPI | 1689697203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 52118) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD26781) |
| 207R00000X Internal Medicine (Licence: MN 104416) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-08-21 |