| NPI | 1932109816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 17244) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 46134) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2015-09-02 |