| NPI | 1700058849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 62559) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND PT10492) |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2023-01-10 |