| NPI | 1861021172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A188084) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.166213) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2025-09-02 |