| NPI | 1821840687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 80316) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34365) |
| Enumeration Date | 2024-04-04 |
| Last Update Date | 2025-08-19 |