| NPI | 1225244221 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 17686) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 10007) |
| 207R00000X Internal Medicine (Licence: MN 68450) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2025-02-11 |