| NPI | 1841770856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148859) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125071657) |
| Enumeration Date | 2018-08-19 |
| Last Update Date | 2021-06-24 |