| NPI | 1750616157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 53720) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 61297) |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2016-03-01 |