| NPI | 1700092160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 16758) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101261991) |
| 207R00000X Internal Medicine (Licence: OH 35-093307) | |
| 207R00000X Internal Medicine (Licence: CO DR.0059742) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2019-09-04 |