| NPI | 1558980052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 80065) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 70289) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2025-08-22 |