| NPI | 1942204383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 39961) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 33982) |
| 207R00000X Internal Medicine (Licence: MN 107529) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2020-08-13 |