| NPI | 1831583194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 65154) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME134612) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2020-08-12 |