| NPI | 1285339390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2025040073) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125081154) |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2025-09-15 |