| NPI | 1992238471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 70110) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 10964188-1205) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2021-09-09 |