| NPI | 1487304002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 74714) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 32524) |
| Enumeration Date | 2022-03-26 |
| Last Update Date | 2025-03-31 |