| NPI | 1902489172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125-077538) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036168972) |
| 208D00000X General Practice (Licence: IL 036168972) | |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2024-04-26 |