| NPI | 1982017778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS14653) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125065070) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2019-02-04 |