| NPI | 1013366962 |
|---|---|
| Former Name | KENNETH MICHAEL GRUEN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T6578) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 83266) |
| 207R00000X Internal Medicine (Licence: MO 2016019452) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2023-02-23 |