| NPI | 1649809641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.085073) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102208674) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-12-31 |