| NPI | 1679129654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 77659) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 33466) |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2024-08-16 |