| NPI | 1164928503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 65869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 29164) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2021-09-15 |