| NPI | 1386066173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 107868) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01091148A) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2023-07-27 |