| NPI | 1922501741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A181929) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 21169) |
| Enumeration Date | 2018-03-18 |
| Last Update Date | 2025-03-27 |