| NPI | 1851915557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 74299) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-11780) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2023-10-24 |