| NPI | 1376287946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME173522) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.080882) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2025-10-15 |