| NPI | 1568809986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MN 61562) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MN 25403) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2021-09-13 |