| NPI | 1730561259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61171420) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125067718) |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2024-02-16 |