| NPI | 1629643994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125-078039) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2024011938) |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2026-06-29 |