| NPI | 1104041797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1014913) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036121158) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2025-08-06 |