| NPI | 1316407653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 77027) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 30048) |
| 207R00000X Internal Medicine (Licence: MN 67765) | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2022-11-23 |