| NPI | 1083134704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125071151) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 24703) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2024-02-21 |