| NPI | 1295056497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 56586) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 61275-20) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2026-01-20 |