| NPI | 1104404748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036171758) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.078544) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2024-09-11 |