| NPI | 1699303578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 69575) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 30856) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2024-01-22 |