| NPI | 1497129357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD209997) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.074856) |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2022-08-03 |