| NPI | 1972997948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036144696) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125067127) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2021-03-26 |