| NPI | 1356611958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 76519) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125057443) |
| 207R00000X Internal Medicine (Licence: ND 12699) | |
| 207R00000X Internal Medicine (Licence: TX Q9262) | |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2023-05-17 |