| NPI | 1851690622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A122389) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 26175) |
| 207R00000X Internal Medicine (Licence: AZ 67717) | |
| Enumeration Date | 2011-03-19 |
| Last Update Date | 2024-08-02 |