| NPI | 1073568259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036135598) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 5220) |
| 207R00000X Internal Medicine (Licence: KY 44624) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2022-01-04 |