| NPI | 1366753931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 60588) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125058853) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2021-03-30 |