| NPI | 1720011919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 0326093499) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-093499) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2021-12-16 |