| NPI | 1639559719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036144667) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125067282) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2021-08-17 |