| NPI | 1790170629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301115803) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036144044) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2021-10-29 |