| NPI | 1972524676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 31895) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-094716) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2020-12-21 |