| NPI | 1578191698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.178129) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 0S022723) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2026-06-29 |