| NPI | 1689718637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 49588) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 49588) |
| 207R00000X Internal Medicine (Licence: WI 62724-20) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2015-12-02 |