| NPI | 1174364525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 80449) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34415) |
| Enumeration Date | 2024-05-31 |
| Last Update Date | 2025-08-05 |