| NPI | 1871174193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 71984) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 31654) |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2024-07-09 |