| NPI | 1578245262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 77475) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 33399) |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2024-08-08 |