| NPI | 1962407429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 10335) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV 10335) |
| 207R00000X Internal Medicine (Licence: AZ 41762) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2022-09-22 |