| NPI | 1578552246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: IL 036-062967) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-062967) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2020-03-03 |