| NPI | 1649434408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 72328) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2010022098) |
| 207R00000X Internal Medicine (Licence: AZ 48643) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2025-12-22 |