| NPI | 1922078104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 25851) |
| Additional Taxonomies | 174400000X Specialist (Licence: MN 025851) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2014-07-29 |