| NPI | 1265060305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 69576) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 30759) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2021-07-15 |