| NPI | 1104568146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 74751) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 32803) |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2023-07-17 |