| NPI | 1407387707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 64049) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 28317) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2022-01-09 |