| NPI | 1548962707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 77565) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 33356) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2024-08-09 |