| NPI | 1952808446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 65941) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 29594) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2021-10-26 |