| NPI | 1922265784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 50044) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 44003) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2017-06-22 |