| NPI | 1124657978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 38579) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 69712) |
| 207R00000X Internal Medicine (Licence: MN 30902) | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2026-02-11 |