| NPI | 1235794520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO3013) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV SL1423) |
| 208D00000X General Practice (Licence: NV DO3013) | |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2022-10-17 |