| NPI | 1740919588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036176169) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R3747) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2025-07-30 |