| NPI | 1104404524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-166500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.077544) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2024-06-19 |