| NPI | 1952385114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 102423) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 5242) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2021-03-10 |