| NPI | 1124759741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 36859) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: IL 125079466) |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2023-06-27 |