| NPI | 1689243875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO3739) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021022955) |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2024-07-31 |