| NPI | 1609515519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036173293) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125079949) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2025-05-14 |