| NPI | 1699268128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036154912) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.072871) |
| Enumeration Date | 2018-06-09 |
| Last Update Date | 2025-11-19 |