| NPI | 1679222566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 82810) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 82810) |
| Enumeration Date | 2022-03-20 |
| Last Update Date | 2026-07-09 |