| NPI | 1366143513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 80276) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34301) |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2025-08-19 |