| NPI | 1992549166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 80236) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34258) |
| Enumeration Date | 2024-06-22 |
| Last Update Date | 2025-07-23 |