| NPI | 1881218600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 332372) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.076782) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2022-09-05 |