| NPI | 1689867137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 53787) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 53787) |
| 207R00000X Internal Medicine (Licence: MN 53787) | |
| Enumeration Date | 2007-08-18 |
| Last Update Date | 2023-08-17 |