| NPI | 1790368249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 71901) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 31604) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2022-08-15 |