| NPI | 1063580413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 25933) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI YL058737) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2025-06-04 |