| NPI | 1639817075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2025026134) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125079921) |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2025-08-27 |