| NPI | 1831538164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 66578) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 84058) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2020-03-16 |