| NPI | 1235635137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 75818-21) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.072794) |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2021-08-09 |