| NPI | 1487357810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 77504) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 33307) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2024-08-16 |