| NPI | 1063944072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 64051) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 28316) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2020-08-11 |