| NPI | 1659758308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: MN 63292) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 63292) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2020-06-09 |