| NPI | 1053451955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 13058) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 53666-20) |
| 207R00000X Internal Medicine (Licence: NY 230984-1) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2023-12-12 |