| NPI | 1710418892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-163643) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 73188) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2023-04-25 |