| NPI | 1902246465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 63242) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101020750) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2018-01-22 |