| NPI | 1013302884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 62666) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 18068) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2022-08-16 |