| NPI | 1508247446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO2713) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 04362) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2022-11-01 |