| NPI | 1891744140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 65959) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 2534) |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2020-12-04 |