| NPI | 1306457312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.164275) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.076518) |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2025-01-06 |