| NPI | 1356652788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 16969) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 47703) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2022-07-21 |