| NPI | 1578213070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 74828) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 32533) |
| Enumeration Date | 2022-03-27 |
| Last Update Date | 2023-07-18 |