| NPI | 1578573275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036159142) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 44821) |
| 207R00000X Internal Medicine (Licence: WI 68390) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2022-04-26 |