| NPI | 1528828282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 27917) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NV LL4184) | |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2025-10-02 |