| NPI | 1801181037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036128602) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P3008) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2025-01-08 |