| NPI | 1821380551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 15869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD443525) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2021-12-17 |