| NPI | 1790970341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 54551) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 54551) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: MN 54551) | |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2020-03-23 |