| NPI | 1881006104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 68847) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-259388) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2026-01-16 |