| NPI | 1922593730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.072447) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 83193) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2024-10-30 |