| NPI | 1780905273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 22955) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 16577) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2023-08-08 |