| NPI | 1174393409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 34081) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 1-026-418-2) |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2024-01-08 |