| NPI | 1679191050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 83186) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE TEP8866) |
| Enumeration Date | 2020-07-11 |
| Last Update Date | 2026-08-06 |