| NPI | 1891013140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 59188) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 16015) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2020-08-18 |