| NPI | 1265105472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036175012) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 9023) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2026-01-22 |