| NPI | 1659570992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 20252) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 30040) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2022-11-01 |