| NPI | 1588325609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 75366) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 32692) |
| Enumeration Date | 2022-01-02 |
| Last Update Date | 2023-09-22 |