| NPI | 1770094153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO2846) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101023688) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2023-08-17 |