| NPI | 1033775440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 34271) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 30059) |
| 207R00000X Internal Medicine (Licence: MN 67775) | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2023-03-30 |