| NPI | 1285294389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 67729) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 30240) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2020-08-27 |