| NPI | 1366797045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 13115) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125062454) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2023-12-26 |