| NPI | 1700346723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.157724) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.075252) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2022-05-15 |