| NPI | 1689168205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: IL 036.165345) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.072520) |
| 2085R0001X (Licence: IN 01093525A) | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2025-08-22 |