| NPI | 1033453519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036147722) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125061845) |
| Enumeration Date | 2012-11-21 |
| Last Update Date | 2019-03-01 |