| NPI | 1811344823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 62540) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 390200000) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MN 62540) | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2021-06-24 |