| NPI | 1548903818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-176154) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351049924) |
| Enumeration Date | 2022-04-15 |
| Last Update Date | 2025-09-05 |