| NPI | 1760589543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 20687) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 3145) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-08-22 |