| NPI | 1053816520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.155370) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.073051) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2021-07-08 |