| NPI | 1184428955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 83081) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 35214) |
| Enumeration Date | 2025-04-02 |
| Last Update Date | 2026-07-23 |