| NPI | 1508421371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO3024) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV SL1431) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2022-07-06 |