| NPI | 1922483445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 80328) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 19545) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2025-10-01 |