| NPI | 1578635173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 03657432) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-57432) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2023-05-25 |