| NPI | 1659958379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 72050) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 31659) |
| Enumeration Date | 2021-03-27 |
| Last Update Date | 2022-08-11 |