| NPI | 1073242087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 79960) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125080597) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2025-06-26 |