| NPI | 1306309935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 22011) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R77263) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2022-06-06 |