| NPI | 1972944544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 51927) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 25651) |
| 207R00000X Internal Medicine (Licence: WA MD61200000) | |
| 207R00000X Internal Medicine (Licence: AL MD.49803) | |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2024-12-23 |