| NPI | 1508650474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 83040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 35195) |
| Enumeration Date | 2025-04-07 |
| Last Update Date | 2026-07-14 |