| NPI | 1780677211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036062559) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME154788) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2026-07-16 |