| NPI | 1629655535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MN 71920) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 71920) |
| 207R00000X Internal Medicine (Licence: MN 31613) | |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2024-02-28 |