| NPI | 1346090628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: IL 209030352) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209030352) |
| Enumeration Date | 2024-03-27 |
| Last Update Date | 2026-04-29 |