| NPI | 1770963266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A153097) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.066258) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2021-12-17 |