| NPI | 1841919636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 84912) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125080565) |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2025-07-21 |