| NPI | 1265748404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 56944) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125056488) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2024-11-04 |