| NPI | 1811377229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN .) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125066610) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2020-10-06 |