| NPI | 1477903573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 66292) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2016017327) |
| 207R00000X Internal Medicine (Licence: NV 18986) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-12-01 |