| NPI | 1508626722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 80272) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34245) |
| Enumeration Date | 2024-03-22 |
| Last Update Date | 2025-08-07 |