| NPI | 1265096184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 343993) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125077221) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2024-10-08 |