| NPI | 1700292208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 390200000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND PT14741) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2022-07-21 |