| NPI | 1841967270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 72038) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 31767) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2022-08-23 |