| NPI | 1700447117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 33344) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 67810) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2024-10-18 |