| NPI | 1841604485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 60407) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 660) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2024-12-19 |