| NPI | 1841604485 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 60407) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 660) | 
| Enumeration Date | 2014-06-11 | 
| Last Update Date | 2024-12-19 |