| NPI | 1639639263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036161492) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 12345) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2022-10-03 |