| NPI | 1962909978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO3057) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102205905) |
| Enumeration Date | 2018-04-07 |
| Last Update Date | 2022-01-19 |