| NPI | 1518306570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2022-1256) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125063902) |
| 207R00000X Internal Medicine (Licence: WA MD61203457) | |
| 207R00000X Internal Medicine (Licence: KS 04-40350) | |
| Enumeration Date | 2013-06-22 |
| Last Update Date | 2024-03-13 |