| NPI | 1255077335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 79924) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 85714) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2025-09-17 |