| NPI | 1154900199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IL 036-168169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036168169) |
| 207Q00000X Family Medicine (Licence: IL 125.077726) | |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2026-02-06 |