| NPI | 1912521790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.164670) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.076330) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2024-04-01 |