| NPI | 1104919182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 36116128) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036116128) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2016-06-01 |