| NPI | 1821662552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 1821662552) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.078121) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2021-08-11 |