| NPI | 1366902090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2022030333) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036165452) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2023-08-24 |