| NPI | 1730444852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.137636) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.060795) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2021-12-17 |