| NPI | 1700862232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 10451) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 104666) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2018-08-01 |