| NPI | 1699270744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 77259) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA DO-05856) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2024-11-11 |