| NPI | 1659936557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 72103) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125073635) |
| 207R00000X Internal Medicine (Licence: IL 125.073635) | |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2022-08-03 |