| NPI | 1851144612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 80262) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34249) |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2025-07-31 |