| NPI | 1265410773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 18312) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX E6239) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2020-01-17 |