| NPI | 1760682058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 107806) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 50167) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2021-11-29 |