| NPI | 1245644830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036158685) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 67637) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2025-02-11 |