| NPI | 1356551873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 12464) |
| Additional Taxonomies | 193400000X Single Specialty (Licence: NV 12464) |
| 261QU0200X Clinic/Center, Urgent Care (Licence: NV 12464) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2016-03-22 |