| NPI | 1831643378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61067318) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036147226) |
| Enumeration Date | 2016-08-13 |
| Last Update Date | 2021-05-10 |