| NPI | 1982232914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 69689) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 30905) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2023-12-11 |