| NPI | 1912347790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-139750) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2013021057) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2023-02-02 |