| NPI | 1871835124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 85274) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 0057155) |
| 207R00000X Internal Medicine (Licence: IL 036159176) | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2025-06-26 |