| NPI | 1316506264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61263771) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.074293) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2022-08-31 |