| NPI | 1912220864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036132056) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125057277) |
| Enumeration Date | 2010-03-07 |
| Last Update Date | 2021-03-31 |