| NPI | 1710948161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 57445) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 42692) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2020-11-10 |