| NPI | 1629519061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036152019) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 1629519061) |
| Enumeration Date | 2017-03-18 |
| Last Update Date | 2020-08-06 |