| NPI | 1053715300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C185212) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125065444) |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2023-08-15 |