| NPI | 1780175349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 74903) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.072186) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2021-05-05 |