| NPI | 1225512270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036178982) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.081278) |
| Enumeration Date | 2018-09-15 |
| Last Update Date | 2026-03-16 |