| NPI | 1215630405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.082218) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 036.177211) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2025-11-03 |