| NPI | 1821791633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 77482) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 33349) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2024-07-02 |