| NPI | 1003894627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036108783) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 51093) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2021-09-30 |