| NPI | 1942721758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301509425) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.069810) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2024-01-26 |