| NPI | 1710068432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 41047) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 37839020) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2023-03-07 |