| NPI | 1609420843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 292088) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125075144) |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2022-06-02 |