| NPI | 1144080482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 80345) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34306) |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2025-07-30 |