| NPI | 1760904304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 27836) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.070263) |
| Enumeration Date | 2017-07-15 |
| Last Update Date | 2021-02-26 |