| NPI | 1336646249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 22351) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 75567-20) |
| 207R00000X Internal Medicine (Licence: NY 311941) | |
| Enumeration Date | 2018-04-07 |
| Last Update Date | 2022-09-30 |