| NPI | 1720519754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036156024) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R4572) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-02-08 |