| NPI | 1689665283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 43731) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 37003) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2025-12-06 |