| NPI | 1538423991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 70821-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125060782) |
| Enumeration Date | 2012-06-30 |
| Last Update Date | 2019-09-23 |