| NPI | 1356993018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.075193) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125075193) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2019-07-12 |