| NPI | 1720665300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 71940) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 31625) |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2022-08-19 |