| NPI | 1841511243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 60901) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2010017374) |
| Enumeration Date | 2010-06-20 |
| Last Update Date | 2017-03-29 |