| NPI | 1851913503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.1614136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.075862) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2023-06-26 |