| NPI | 1700035268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 57457) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101246798) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2019-04-09 |