| NPI | 1740084789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 83036) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 35189) |
| Enumeration Date | 2025-04-01 |
| Last Update Date | 2026-07-14 |