| NPI | 1114540861 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: IL 036164499)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.075694)  | 
| Enumeration Date | 2020-05-28 | 
| Last Update Date | 2025-01-09 |