| NPI | 1760187595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 77443) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 33335) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2024-08-01 |