| NPI | 1710140975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036128135) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125054244) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: IL 036128135) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2023-08-25 |