| NPI | 1982929758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 15706) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 8909) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2023-12-05 |