| NPI | 1518427400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.161532) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.073901) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2022-10-11 |