| NPI | 1073141305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 69587) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 30859) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2021-08-30 |