| NPI | 1154881092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 81454) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A179729) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2026-07-17 |