| NPI | 1043884224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 72769) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MN 72769) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2024-06-18 |