| NPI | 1124045133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 78752) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301077185) |
| 207R00000X Internal Medicine (Licence: ND 9581) | |
| 207R00000X Internal Medicine (Licence: SD 12135) | |
| 207R00000X Internal Medicine (Licence: NV 10094) | |
| 207R00000X Internal Medicine (Licence: OH 35-078745) | |
| 207R00000X Internal Medicine (Licence: IN 01053327A) | |
| 207R00000X Internal Medicine (Licence: AZ 33994) | |
| 207R00000X Internal Medicine (Licence: WA MD00044462) | |
| 207R00000X Internal Medicine (Licence: IA MD-48969) | |
| 207R00000X Internal Medicine (Licence: WI 020-42842) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2026-04-18 |