| NPI | 1114214111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036151164) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0078759) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2026-06-16 |