| NPI | 1487397956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 74600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 32473) |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2023-08-28 |