| NPI | 1770386062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 83390) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 35313) |
| Enumeration Date | 2025-03-31 |
| Last Update Date | 2026-07-31 |