| NPI | 1942874516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 72017) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 31675) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2022-08-11 |