| NPI | 1417745209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 83077) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 35238) |
| Enumeration Date | 2025-04-30 |
| Last Update Date | 2026-07-14 |