| NPI | 1891061990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 63495) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036136303) |
| 207R00000X Internal Medicine (Licence: WI 63495-21) | |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2020-10-21 |