| NPI | 1447748322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 76773) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 21293) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2024-05-03 |